The Canon: Unmasking Medicine. By Ian Kennedy

December 10, 2009

Unmasking Medicine was published in 1981 following Ian Kennedy's Reith lectures. Its ideas were intended for, and reached, a wide audience. His central premise was that medicine had been insufficiently scrutinised and, on analysis, was found to be wanting. Notwithstanding its beneficent aims and doctors' altruistic claims, medicine could be, and often was, harmful.

Kennedy, a legal scholar specialising in the ethics of health who was knighted in 2002, demonstrated that notions of disease, illness and health are not morally neutral; that values, ethical judgments and political choices embedded in healthcare warranted elucidation and debate. The state-sanctioned power of the medical profession inhibited decision-making, protected vested interests and had significant socio-political consequences. For a short text, its focus was ambitious, addressing both fundamental epistemological challenge and issue-specific proposals for reform. In both his lectures and the subsequent book, Kennedy said he sought debate about the nature of medicine, and he indubitably succeeded in that aim.

There were swift reactions from many quarters. Doctors responded vociferously, and most were hostile. Indeed, many responses bolstered Kennedy's representation of the medical profession as a closed shop defending vested interests. Social scientists were also critical, and Kennedy said the book received some of the "worst and most bitter reviews" he had encountered in his career.

Yet this work had an immediate influence on the nascent field of bioethics and medical law. It challenged the academic and professional communities to join the public in a radical review of medicine and society. Moreover, it demonstrated that big questions were best viewed through the lens of pluralism. Unmasking Medicine provided stimulus to the development of medical education in general, and bioethics in particular. Kennedy proposed that ethics should be part of the core medical curriculum and opened the door to "tolerated trespassers" like me, who occupy desks in medical schools across the country.

Unmasking Medicine is not flawless. While Kennedy exposed the implicit power and excessive claims of medicine, he did not pay the same attention to his own assumptions. His magpie-like borrowing from academic sources sometimes leads to superficiality, and his mix of analysis and proposals for reform is unconvincing. Significantly, the acerbic language threatens to detract from the message, and many of Kennedy's critics also indulged in sarcasm in return. Perhaps the polemic language can be forgiven: the inherent power in the doctor-patient encounter and the structural support for that imbalance needed attention and Kennedy made it difficult to ignore.

Kennedy's work has influenced me in multiple ways. My own research interests owe much to this text. It first prompted me to consider whether self-regulation could be both a privilege and burden. I share his belief that academics must listen and speak to society at large, and that ethical questions are not the sole preserve of academics or professionals.

Unmasking Medicine serves as a warning about the perils of representing groups, be it doctors, patients or ethicists, as homogeneous. Ultimately, this book reminds me that while doctors enjoy power and privilege, so too do those who contribute to their training and comment on their work.

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